H1N1 Pandemic Precautions for Frontline Workers

If the H1N1 pandemic flu follows the pattern of the 1918 Great Pandemic it could come back with more vigor in a second wave next fall. In 1918, three separate recurrences of influenza followed each other with unusual rapidity, resulting in three pandemic waves within a year's time. Dr. Thomas O'Brien, vice president of the Alliance for the Prudent Use of Antibiotics (APUA) and microbiology lab director at Brigham and Women's Hospital, stated this concern on May 14 before a Congressional Subcommittee, chaired by Congressman Stephen Lynch from the Ninth District of Massachusetts. Lynch called the hearing to consider how to protect federal workers who are first responders during flu epidemics.

The work of APUA is given a special relevance to this danger by recent evidence that secondary bacterial infection was a major contributor to the 1918 influenza death rate and by recent changes in methicillin-resistant Staphylococcus aureus (MRSA). Because of overuse of related antibiotics, MRSA has spread widely in the community in recent years and on multiple occasions has acquired resistance to vancomycin, the drug that has been relied on for treating it. “MRSA will thus be a very likely major contributor to the mortality of future influenza infections, and preventing its further acquisition of antibiotic resistance is necessary to keep those infections from becoming untreatable,” according to O'Brien.

The best defense is to ensure funding for strong state and federal public health programs, said O'Brien. He complimented Dr. Richard Besser, acting director of the CDC and Dr. Alfred DeMaria, director of communicable disease control at the Massachusetts Department of Public Health for their epidemiology investigations and effective communications during the influenza outbreak in April and May. He emphasized the importance of disease tracking programs and the need for simple but critical everyday hygiene measures such as vigorous handwashing with soap and water or alcohol gels for all citizens. For surface disinfection, APUA recommends soap and water or use of bleach and alcohol antiseptics. Emphasis for frontline workers and the general public should be on the proven protections of good hygiene and handwashing and not on an unproven need for facemasks. Facemasks are currently only recommended for healthcare professionals with prolonged exposure to patients diagnosed with H1N1.

O'Brien cautioned against unnecessary or over use of antibiotics and antivirals, such over-use leaves the medical community without effective antiviral or antibiotic drugs when the need is greatest.